#125 - Motivational Interviewing and CBT for insomnia
Give yourself time to think about a behaviour of yours right now that you’re trying to change …. and if you aren’t actively changing a behaviour - should you?
Without your consent, you’ve just been part of the world’s biggest experiment.
Many of your health behaviours changed.
Since 2020, we’ve seen sedentary activity increase (Stockwell et al., 2021), alcohol consumption increase (Killgore et al., 2021), screen time increase (Trott et al., 2021), and more people across the world experience sleep problems (Jahrami et al., 2021).
Are you as healthy as your 2019 self?
I know, behavioural change is hard.
And that’s why we all need a little support …
CBT for Insomnia is the Beez Kneez
Most people with sleep issues will either seek help from their family doctor or pharmacist, so there’s a good chance that they’ll receive a ‘pill’ for their sleep.
When I starting working in an Insomnia Clinic, the most common sleep medication people would have tried was Temazepam.
Temazepam is a benzodiazepine.
It is meant to be used in the short-term (ie, 4 weeks or less), and it would benefit a lot of people.
But if used in the long-term, people can habituate to it - meaning Temazepam loses its potency.
And then when people stop taking it, they can experience rebound insomnia (ie, the symptoms of insomnia return).
Likely due to a combo of the rebound insomnia experience - plus that family doctors usually do not warn their patients about the possibility of rebound insomnia - many people get caught in the cycle of using Temazepam on and off and on and off and ….
The collective “We” have known for almost 20 years that sleep medications perform just as well as Cognitive-Behaviour Therapy for Insomnia (CBT-I) in the short-term (Jacobs et al., 2004).
Yet, when comparing these sleep treatments side-by-side, it’s interesting to see what happens when they ‘stop’ …
Soon after treatment stops, almost half of all people taking a ‘medication for sleep’ wish to have a different form of treatment. Sleep medications do not have the long-term benefits that CBT for Insomnia possesses.
Side note - isn’t it interesting that the Placebo group’s time taken to fall asleep was on par with some of the other therapies? Maybe this is why some people visit chiropractors (ouch!).
Yet CBT-I is not all roses and Turkish delights …
Behavioural Treatments for Insomnia are Legit
CBT for insomnia can be known as a modular treatment. That is, it has multiple components; multiple techniques.
The most powerful techniques are the behavioural techniques - the ‘B’ in CBT.
Of the two behavioural therapies for insomnia, Stimulus Control Therapy has the biggest support from sleep science - mainly because it’s been around since the 1970s.
And it’s likely you’ve heard of it.
If you’ve heard that you should get up and go to another room if you cannot sleep in bed - wait till you feel ready to go back to bed - and try to sleep again - then you’ve heard something about Stimulus Control Therapy.
Its inventor - Professor Richard ‘Dick’ Bootzin was an extremely talented, yet humble man.
When praised for his contribution to sleep science and helping millions of people around the world sleep better, he’d say something like “I just saw that the alcohol field were using Stimulus Control for drinking, and I just adapted for insomnia.”
Dick Bootzin was one of the 1st Generation of insomnia sleep scientists. He was a good friend of Professor Leon Lack - my PhD supervisor. So I had the privilege of meeting and getting to know Dick.
Dick knew not only of the strengths, but also the limitations of Stimulus Control Therapy.
It was clear that after roughly 6 weeks of someone performing Stimulus Control Therapy that the amount of time that they would be awake in bed would reduce by more than 50% (that’s one of its strengths)!
What was also clear was that it was an unpleasant therapy. So not everyone who started it, finished it.
And there wasn’t one standout reason for people giving up.
CBT for Insomnia is Painful
Stimulus Control Therapy is known as a behavioural therapy because it involves changing people’s behaviours around sleep.
And behavioural change is not as easy as ‘just add water’!
At the 2010 European Sleep Research Society conference in Lisbon, Professor Eus van Someren claimed “Sleep treatments are painful.”
He went onto say “We’re asking people with insomnia to do things that are unpleasant.”
That’s true.
Whilst sometimes we’re asking people to stay up later - which can be tough - what’s probably worse is asking them to get out of bed during the night.
It goes against what they want. What they sometimes believe. That they’re more likely to fall back to sleep if they’re in bed as opposed to getting up and going to another room.
Motivation + CBT for Insomnia
Whilst most people will follow through with painful suggestions to change their behaviours around sleep - others won’t.
This doesn’t just apply to the behaviour of ‘getting out of bed’ in Stimulus Control Therapy.
But other behaviours associated with sleep.
For instance, how many times have you heard an expert say “Remove all devices from your bedroom”?
“Fuck off” …
… is the likely response from people.
“Avoid drinking too much alcohol before bedtime. It may help you fall asleep, but your sleep quality during the night will suffer.” says the same sleep expert …
“Hey, how about we get another bottle of wine” a friend at dinner asks …
“Ahh, not me thanks. I don’t want my sleep quality to suffer.” said no one ever.
Enter Motivational Interviewing … otherwise known as MI.
MI was originally used to help people change their behaviours around drug and alcohol use.
Then MI was applied gambling.
And then … some wise people thought it might be bonza to apply MI to helping people change their behaviours to improve their health. Whether it was to increase exercise, eat less shit (aka, junk food), get less sunburnt, ensure they take their medication - you name it.
Eventually, some people started to apply MI to sleep.
Whether it was to help people use their CPAP device to treat their sleep apnea, or to help teenagers change their behaviours around sleep.
And yes, it can be used alongside CBT for Insomnia - even helping parents who know that it’s too painful to keep going with an infant that wakes all hours of the night.
I’m gonna predict that a number of people reading this help people sleep by using CBT for Insomnia.
Does that mean you’re competing against other people? People who do the same thing as you?
I use to think like that - “What would make me different to all the other psychologists out there?”
This meant I kept studying. Kept getting qualifications. Kept learning.
When I stumbled upon MI, I felt a buzz.
It was so cool to use. My clients really liked it. And I could use it side-by-side with sleep treatments.
I started researching MI.
I started teaching MI.
And now, you can learn MI.
Forward this email (and cc us at hello@winksleep.online) to someone else you think could do with learning about sleep, and then you can use this 15% off discount code (MOTIV8TION) to use in the next 48 hrs for the certified Motivational Interviewing for Sleep Problems course.
Or don’t. It’s your choice.
Prof MG
p.s. for those who pre-ordered the MI course, we will guide you to download the course. Enjoy!
Helping Teens Sleep Better …
Teaching can be rewarding. You feel like a small part of someone’s journey. That’s why I’m stoked to hear about the successes experienced by Deb Herdman and Tanya Muir. Last week, Tanya became the 1st Certified Teen Sleep Practitioner in her country (South Africa), and also the first Teen Sleep Practitioner on her wonderful continent. So if you live in South Africa and you need somewhere to refer to teen clients, then you can get in touch with Tanya.
On a similar latitude, Deb Herdman from Melbourne was one of the first people to complete WINK’s Certified Training on Teen Sleep Problems. A couple of weeks ago she shared with us her first success working with a teen client …
This is a fantastic result for this teenager - whose sleep pattern was better suited to South Africa than eastern Australia. Needless to say, Deb is someone skilled to help other teens you need to refer - and she can be contacted here.